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Rhabdomyolysis Secondary to Reactivated Herpes Simplex Virus Type 1 Coinfected with Klebsiella pneumoniae in an Elderly Patient: A Case Report
An X, Chen Y.. Research Square, 2026-08-10
Topic: Inflammation, microglia and astrocytes
Rhabdomyolysis is a common syndrome involving the breakdown of muscle tissue. It is a serious condition that may be complicated by acute kidney injury and can even be life-threatening; however, it is highly prone to being missed. To date, no comprehensive domestic or international case reports have described rhabdomyolysis triggered by coinfection with herpes simplex virus type 1 (HSV-1) and Klebsiella pneumoniae. This is the first documented case of occult rhabdomyolysis driven by latent HSV-1 reactivation (without concomitant encephalitis or seizures) and concurrent Klebsiella pneumoniae infection. For bedridden elderly patients with dementia, routine testing for creatine kinase (CK) and myoglobin is recommended to facilitate early diagnosis of rhabdomyolysis, prevent acute kidney injury and multi-organ dysfunction. After targeted anti-infection therapy, sufficient fluid resuscitation combined with nutritional and immune supportive care, the patient’s creatine kinase and inflammatory biomarkers normalized, and clinical status improved gradually. We hypothesize that the rhabdomyolysis was caused by a herpes simplex virus infection complicated by a Klebsiella pneumoniae coinfection. This case represents the first reported instance of cryptic rhabdomyolysis induced by latent HSV-1 reactivation (without encephalitis or seizures) combined with Klebsiella pneumoniae infection. Clinicians should routinely test CK and myoglobin levels in elderly bedridden dementia patients to achieve early intervention and prevent kidney injury. Elderly patients with dementia who are bedridden and have intervention and prevent kidney injury and multi-organ failure.
Key findings
- After targeted anti-infection therapy, sufficient fluid resuscitation combined with nutritional and immune supportive care, the patient’s creatine kinase and inflammatory biomarkers normalized, and clinical status improved gradually.
- We hypothesize that the rhabdomyolysis was caused by a herpes simplex virus infection complicated by a Klebsiella pneumoniae coinfection.
- This case represents the first reported instance of cryptic rhabdomyolysis induced by latent HSV-1 reactivation (without encephalitis or seizures) combined with Klebsiella pneumoniae infection.
- Clinicians should routinely test CK and myoglobin levels in elderly bedridden dementia patients to achieve early intervention and prevent kidney injury.
- Elderly patients with dementia who are bedridden and have intervention and prevent kidney injury and multi-organ failure.
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Study details
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 21 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 13 of the 62 points we could judge it on, which is 21 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 13 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 13 of the 62 points we could judge it on is 21 out of 100. |
| Total | 21 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
An, X., & Chen, Y. (2026). Rhabdomyolysis Secondary to Reactivated Herpes Simplex Virus Type 1 Coinfected with Klebsiella pneumoniae in an Elderly Patient: A Case Report. Research Square. https://doi.org/10.21203/rs.3.rs-10288569/v1
Vancouver
An X, Chen Y. Rhabdomyolysis Secondary to Reactivated Herpes Simplex Virus Type 1 Coinfected with Klebsiella pneumoniae in an Elderly Patient: A Case Report. Research Square. 2026. doi:10.21203/rs.3.rs-10288569/v1.
BibTeX
@article{an2026-91a40936,
author = {An, X. and Chen, Y.},
title = {{Rhabdomyolysis Secondary to Reactivated Herpes Simplex Virus Type 1 Coinfected with Klebsiella pneumoniae in an Elderly Patient: A Case Report}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10288569/v1},
url = {https://doi.org/10.21203/rs.3.rs-10288569/v1}
}
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